Re: transport time (school assignment)

[Wildmedic75@cs.com]

<< Our ground time for transport was 30 minutes to the trauma 
 center. The air transport time was 40 minutes. My department is ACLS,PALS 
 and BTLS certified. My question is Should we wait the 10 minutes for the air 
 transport or should we by pass the air transport for the faster time to the 
 trauma center ? >>

Mark,

Hello there; my name is Allan Bulkley. I'm a full time flight medic at Mercy 
Flight of WNY.

Thank you for asking these legitimate questions. In fact. the questions you 
raise (there are actually 2) are so interesting and valid that they are asked 
very often: 

1) Which method of transport truly is quicker; ground or air?
2) Even if we have to wait a few extra minutes for the helicopter, will our 
patient still potentially benefit?

    First, I am curious...where you got your data? I can tell you with 
absolute certainty that any info you have saying that helicopter transport 
time from Lockport to ECMC is 40 minutes is flawed; from the LZ in Lockport 
to the rooftop at ECMC it is about 7 minutes by air; obviously a significant 
time savings over ground transport. I assume that the data you are looking at 
is comparing time of initial dispatch (when you guys call us) to the time we 
arrive at ECMC, vs the "ground data", which must look at the time you guys 
leave the scene to the time you get to ECMC. This really is apples and 
oranges.  

    One thing that we stress when we do ground schools is to ALWAYS CALL US 
EARLY. This is the only way the system will work efficiently. If we are not 
called until you are at the scene, or worse yet, until after the patient is 
assessed and packaged, then there probably is little if any time savings in 
air transport, and the patient does not benefit from a shorter pre-hospital 
time. 

    However, if we are put on an "airborne standby" as soon as you are 
dispatched to a call that meets criteria, then we can be arriving at the LZ 
at about the same time as (quite possibly before) you, and as long as the 
patient is already properly assessed and immobilized (a BIG source of wasted 
time for us is having to re-immobilize patients), and we DON'T have an airway 
problem or other critical intervention to perform, we will be off the ground 
headed to the county about 5 minutes after making patient contact - a net 
time savings of probably about 15 minutes. 

    Does this make a difference in outcome? Who knows...it depends on many 
factors....but shouldn't we always err on the side of caution? 

    As for the second question; "Does the patient benefit from air transport 
even if it is not quicker?"; I have to honestly say that I don't know. The 
research in this area is inconclusive.

    I can't make the "we can do more" argument because unfortunately, we 
don't operate under the same sort of expanded scope that many flight services 
do (not yet - that is hopefully changing soon), so with the exception of RSI 
for a patient who needs it, there's not alot we can do that you guys can't. 
    
    However, intervention capabilities aside, consider the benefit of having 
care provided by two seasoned, well trained crew members (flight medic/flight 
nurse) who assess and manage serious trauma patients on a regular basis vs. 
having a lone paramedic (I assume that's your crew configuration) in the back 
of the ambulance with that patient. As a former full-time ground paramedic 
(still part-time) who is used to working alone with ALL TYPES of patients, I 
can personally attest that with a serious patient, it can make a significant 
difference in the quality of care provided enroute to the hospital. 
    
    There's also the local resource factor....if you guys are out of service 
for 1.5 - 2 hours transporting a patient to ECMC, doing paperwork, cleaning 
your rig, and driving back to Lockport, who covers your city? I know you 
probably have more than one ambulance, but  the resource issue still may be a 
factor to consider. 
    
    In summary, I want to emphasize that as long as we are dispatched when we 
should be (at the same time as you guys for calls that meet criteria), then 
there is NO situation in which air transport is not SIGNIFICANTLY faster than 
ground transport from your location to the regional trauma center. 
    
    Also, even if we aren't going to be significantly quicker, there may be 
other totally appropriate reasons to use us as well.

    I am interested in hearing more about your research, specifically where 
you collected your data and how it was compiled. Maybe I can help...we've got 
lots of retrospective data on file in our communications center. I'd also 
like to talk more about the practical aspect of your utilization of us....in 
other words, how can we make it easier for you to use us, and how can we work 
together to make the system smoother and more efficient? Please respond 
privately..... 

Thanks,

Allan Bulkley
Flight Paramedic
Mercy Flight of WNY 

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